Host Parasite Relationship

December 8, 2021 Dr.
Salwa Tayel 1
Infectious Disease Epidemiology
By
Associate Professor
Family and Community Medicine Department
King Saud University
December 8, 2021 Dr. Salwa Tayel 2

Learning Objectives
At the end of this lecture you (will) be able to:
Understand definitions used in infectious

disease epidemiology.
Study natural history of infectious diseases

and its Implications for public health.

Definitions
Epidemiology is the study of

distribution and
determinants of
health-related events in specified populations and
the application of this study to prevent and control
of health problems.

Distribution
 Person……….
 Place…………..
 Time……………
Describe disease
Incidence Rate……
Prevalence Rate……
Dr. Salwa Tayel 5

December 8, 2021
Disease Determinants
HOST
AGENT ENVIRONMENT
The Epidemiologic Triad

Dr. Salwa Tayel 6
December 8, 2021
Definitions
Infection:
It is the entry, development and multiplication of an
infectious agent in the body of man or animal.
Outcome of infection varies.
Infectious disease:
A clinically manifest disease of man or animal resulting from
infection.
In-apparent infection:
The infection does not become manifest at any stage.

Communicable Disease
An illness due to a specific infectious agent or its

toxic products that arises through transmission
of that agent from reservoir to susceptible host.
Communicable Disease versus
Non- Communicable Disease

Contamination:
The presence of living infectious agents on the
exterior surface of the body or on the clothes or
articles of the person or on any inanimate object in
the environment including water and food.
Contagious diseases
A disease that is capable of being transmitted from
one person to another by contact or close
proximity. e.g. scabies, trachoma and leprosy.

Endemic
The constant presence of a disease or infectious
agent within a given geographic area or population
group; may also refer to the usual prevalence of a
given disease within such area or group.
Epidemic
The occurrence of more cases of a disease than
expected in a given area or among a specific
group of people over a particular period of time.

Pandemic
An epidemic occurring over a very wide area (several

countries or continents) at the same time and usually
affecting a large proportion of the population.
e.g. Influenza, cholera
Outbreak
A more or less localized epidemic affecting large number of

a group, in the community
e.g. outbreak of food poisoning

Sporadic
Cases occur irregularly, haphazardly from time

to time and generally infrequently.
Cases are few and separated widely in space and

time showing no connection to each other.

Nosocomial infection (Hospital acquired infection):
It is an infection occurring in a patient while in a
hospital or other health care facility
It should not be present or incubating at the time of
admission.

Elimination of disease
Disease incidence is reduced to a minimal level at
which the disease is no longer considered a public
health problem, while infection may still occur
Example:
The aim of elimination of Neonatal tetanus is
reduction of its incidence to less than
one case/1000 live births.

Eradication:
 It means worldwide disappearance of a

disease (permanent reduction to zero level)
with complete destruction of the agent.
The organism can be present only in

laboratories and no need for interventions.
e.g. smallpox eradication from the world since

1979.

Cause of disease.
A factor (characteristic, behavior, event, etc.) that directly
influences the occurrence of disease. A reduction of the
factor in the population should lead to a reduction in the
occurrence of disease.
Risk factor:
An aspect of personal behavior or lifestyle, an
environmental exposure, or an inborn or inherited
characteristic that is associated with an increased
occurrence of disease or other health-related event or
condition.

Natural history
Natural history of disease refers to the progress of a
disease process in an individual over time, in the
absence of intervention.
The natural history of a disease describes the course
of the disease in an individual starting from the moment
of exposure to the causal agents till one of the possible
outcomes occurs.

Spectrum of disease
The idea that an exposure can lead to varying signs,
symptoms and severity of the same disease in the population
is the spectrum of disease.
Why do we have varying degrees of severity?
The outcome will depend on the interactions of host, agent
and environmental factors.

Disease Determinants
HOST
AGENT ENVIRONMENT
The Epidemiologic Triad

The epidemiologic triad Model
The epidemiologic triangle or triad is the traditional
model of infectious disease causation.
It has three components: an external agent, a

susceptible host, and environment factors that
interrelate in a variety of complex ways to produce
disease in humans.

Agent factors
Agent refer to an infectious microorganism—virus,
bacterium, parasite, or other microbe.
Generally, these agents must be present for disease to
occur.
That is, they are necessary but not always sufficient
to cause disease.

Host factors
Host factors are intrinsic factors that influence an individual’s
exposure, susceptibility, or response to a causative agent.
Host factors which affect a person’s likelihood of exposure:

e.g. Age, race, sex, socioeconomic status, and behaviors
(smoking, drug abuse, lifestyle, sexual practices and
contraception, eating habits)
Host factors which affect susceptibility and response to an agent:
Age, genetic composition, nutritional and immunologic status,
anatomic structure, presence of disease or medications, and
psychological makeup.

Environmental factors
Environmental factors are extrinsic factors which affect the
agent and the opportunity for exposure.
Environmental factors include:

– physical factors such as geology, climate, and physical
surroundings (e.g., a nursing home, schools);
– biologic factors such as insects that transmit the agent; and
– socioeconomic factors such as crowding, sanitation, and the

availability of health services.

Factors Affecting Disease Transmission
and Symptomatic Clinical Disease
VECTOR -- Susceptibility
-- Prevalence Host -- Immune response
-- Portal(s) of entry -- Resistance
--- Portal(s) of entry
Vector
Agent Environment
-- Balance of immune to
-- Virulence Toxigenicity susceptible individuals
-- Infectivity Resistance --- Opportunity for
-- Pathogenicity Antigenicity exposure (e.g. crowding)
Terms used to describe an infectious disease
1. Infectivity refers to the proportion of exposed persons who
become infected (secondary attack rate).
2. Pathogenicity refers to the proportion of infected persons

who develop clinical disease (clinical/subclinical ratio).
3. Virulence refers to the proportion of persons with clinical

disease who become severely ill or die (case fatality rate).

Classification of diseases according to spectrum
Class A: Inapparent infection
Examples: Tuberculosis, Polio, Hepatitis A, Meningitis, AIDS

(Low pathogenicity and low virulence)

Class B: Classic cases
Examples: Measles, Chickenpox

(High pathogenicity & low virulence)

Class C: Severe or Fatal infections
Examples: Rabies, Hemorrhagic fevers caused by Ebola

and Murberg viruses.
(High pathogenicity & high virulence)

Implications for public health

Iceberg phenomenon
Cases of illness correctly diagnosed by clinicians in the
community often represent only the “tip of the iceberg.”
Many additional cases may be too early to diagnose or may

remain asymptomatic.
Examples: Tuberculosis, meningitis, polio, hepatitis A, AIDS.
The risk is that persons with in-apparent or undiagnosed

infections may be able to transmit infection to others.

Timelines for Infection and Symptomatic Disease
Dynamics of noninfectious
infectiousness latent infectious -- removed
period period -- dead
susceptible -- recovered
E time
-- dead
Dynamics of incubation symptomatic -- recovered
disease period period -- immune
-- carrier
susceptible
time
The pyramid and iceberg of disease
1 Diseased, diagnosed & controlled
Diagnosed
disease
2 Diagnosed, uncontrolled
3 Undiagnosed or wrongly
diagnosed disease Undiagnosed or
wrongly diagnosed disease
4 Risk factors for disease
5 Free of risk factors

Applications of the concepts of natural history
and spectrum of disease
Persons with in-apparent or undiagnosed infections can

transmit infections to others.
Control measures must not be directed solely for clinically
apparent cases.
Control measures must be directed toward all infections
capable of being transmitted to others;
– both clinically apparent cases and
– those with in-apparent or undiagnosed infections.

The End
Thank You
salwatayel@hotmail.com

Host Parasite Relationship

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December 8, 2021 Dr.

December 8, 2021 Dr. Salwa Tayel 2

At the end of this lecture you (will) be able to:

Understand definitions used in infectious

Study natural history of infectious diseases

December 8, 2021 Dr. Salwa Tayel 3

Epidemiology is the study of

December 8, 2021 Dr. Salwa Tayel 4

Dr. Salwa Tayel 5

The Epidemiologic Triad

December 8, 2021 Dr. Salwa Tayel 7

An illness due to a specific infectious agent or its

December 8, 2021 Dr. Salwa Tayel 9

December 8, 2021 Dr. Salwa Tayel 10

December 8, 2021 Dr. Salwa Tayel 11

An epidemic occurring over a very wide area (several

e.g. Influenza, cholera

A more or less localized epidemic affecting large number of

e.g. outbreak of food poisoning

December 8, 2021 Dr. Salwa Tayel 12

Cases occur irregularly, haphazardly from time

Cases are few and separated widely in space and

December 8, 2021 Dr. Salwa Tayel 13

It is an infection occurring in a patient while in a

hospital or other health care facility

It should not be present or incubating at the time of

December 8, 2021 Dr. Salwa Tayel 14

December 8, 2021 Dr. Salwa Tayel 15

 It means worldwide disappearance of a

The organism can be present only in

e.g. smallpox eradication from the world since

December 8, 2021 Dr. Salwa Tayel 16

December 8, 2021 Dr. Salwa Tayel 17

disease process in an individual over time, in the

The natural history of a disease describes the course

of the disease in an individual starting from the moment

of exposure to the causal agents till one of the possible

December 8, 2021 Dr. Salwa Tayel 18

The idea that an exposure can lead to varying signs,

symptoms and severity of the same disease in the population

is the spectrum of disease.

Why do we have varying degrees of severity?

The outcome will depend on the interactions of host, agent

and environmental factors.

December 8, 2021 Dr. Salwa Tayel 20

The Epidemiologic Triad

It has three components: an external agent, a

December 8, 2021 Dr. Salwa Tayel 22

Agent refer to an infectious microorganism—virus,

bacterium, parasite, or other microbe.

Generally, these agents must be present for disease to

That is, they are necessary but not always sufficient

December 8, 2021 Dr. Salwa Tayel 23

Host factors which affect a person’s likelihood of exposure:

December 8, 2021 Dr. Salwa Tayel 24

Environmental factors include:

– socioeconomic factors such as crowding, sanitation, and the

December 8, 2021 Dr. Salwa Tayel 25

2. Pathogenicity refers to the proportion of infected persons

3. Virulence refers to the proportion of persons with clinical

December 8, 2021 Dr. Salwa Tayel 27

Class A: Inapparent infection

Examples: Tuberculosis, Polio, Hepatitis A, Meningitis, AIDS